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3/21/94 <br /> Date P„o�.,�,o,.,�.,�,.�. <br /> Applicallon For ema oeui . _�L �6 _ <br /> PUBLIC WORKS PERMIT PuLTul�FeeFee s = <br /> Ufe�oV� iee Pe�d s_. _ � <br /> PrintorTypeOnly TO POSTlNG S �� %5— �r,,.P�„= S ______ <br /> George Mos1e 2720 Fulton Evcrezt 98201 25N-443G <br /> Owner Mailing Atldress Ctly Lp Phone <br /> Same <br /> Applicant Meiling Address Gty 2ip Phone <br /> DescnbePioposedWork ���r 'VQ� `� '1 �- _.____� _ __ <br /> Prolect Address lil knownl ��� , '7/ � ��.:J _ — � <br /> Altach fow(4)copies ol plans fm pronoseA viurk- Draw to scale ane note R+e follov�inq as appliCable�. � <br /> • Property Lines • Cenlerline ol strwet /w, <br /> • Ou�line and dimecsions ol ell e�isting and • Indicate North V� <br /> proposetl s�iuctwes on Ihe lol • Show any proposed grading changes <br /> • Existing and proposed utilities • Shuw measuremenis � <br /> DO NOT 1VRiTE BELOW THIS LINE O <br /> PEqM1T CONDITIONS <br /> 1.All call�lor Inepection ahall be made 24 hrs.in;:dvance•phone 259•8810. � <br /> 2.All work aholl be perlorned in eccordance with thfe permlt and current City ol Everett Daelgn end Conatruction <br /> Standerds and Specllicationa. <br /> 3.Cell Locstlon Underground Service 48 h�s.before yau dig.TOLL FREE NUMBER 1•800•424•5555. � <br /> O <br /> PUBIIC WORKS PERMIT � <br /> NOT REOUIHED � <br /> BY <br /> DATE_�� 2 O <br /> a <br /> ACI�.NOWLEDGEMENT OF CONDI710NS <br /> The undersigned owner/applicant hereby agreo5 to hold and save harm� <br /> ' � ---- lesc Ihe City ol Everett from eny and all claims �or damegos. cosls. <br /> ezpenses. or causes ol action that may arise becausF� ol installation <br /> and mainlenance ol the improvement or olher rlghbol•.vay use her�lo <br /> appl�eA lor and lu��hei aqrees lo remove 5ame upon noth;e hom ihe <br /> APP���Pd for Conscruction Dale Qty and lo replace public prope�ty damagetl thereby. <br /> FIYAL I45PECilON Dale __ ___ __ <br /> ApproveA as Constiucted S�gna�ure of Applicant Da�u <br /> �� PUBUCWORKSOEPARTMENT WORK AUTHORIZED BV i�HIS PERMIT MUST BE °i7AH'(ED WITHIN <br /> 3200CedarSlrent 180 DAVS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br /> �� Eve�ett,WA 9A701 BE DILIGENTLV PURSUEC TO CUMPLETION. THIS PERMIT MAV BE <br /> °hooe'259�BBt0 CAIlCELLFD 81'TNE CITV UPON ANV STOFPAGE 01-NIORH ON TNIS <br /> � PROJECT OVER 9J DAYS DURA�ION. <br />